Review: 'The Answer to the Riddle Is Me' by David MacLean

David MacLean, author of "The Answer to the Riddle Is Me," suffered memory loss in India in 2002 after taking an anti-malarial drug.

David MacLean, author of "The Answer to the Riddle Is Me," suffered memory loss in India in 2002 after taking an anti-malarial drug. (Abel Uribe, Chicago Tribune)

Jenni Laidman

It's hard to be too sad when bad things happen to good writers.

Don't get me wrong. I would not wish what happened to David Stuart MacLean on even a miserable writer. But if bad things are going to happen, we are lucky when they happen to someone with the wit, humanity and sweetness — to say nothing of an eye for detail and a gift for pacing — that MacLean brings to this wrenching tale, "The Answer to the Riddle is Me."

I was standing when I came to. Not lying down. And it wasn't a gradual waking process. It was darkness darkness darkness, then snap. Me. Now awake.

It was hot. My thin shirt clung to my back and shoulders, and my underwear was bunched into a sweaty wad. … I was in the center of a crowd, half surging for the train, half surging for the exits. I stood still. I had no idea who I was. This fact didn't panic me at first. I didn't know enough to panic.

This chilling awakening and the gut-deep confusion that follows are lit with flashes of detail: a door lacquered so thickly, he startles at his own reflection; three silver-painted boys dancing through traffic, hands out for rupees. But he is like a camera shutter, open into full-color consciousness, then snapping shut into viscous darkness.

When awake, there's a sense of panic, of small things crowding in, overwhelming his dim sense of his missing self, followed sometimes by floods of relief when anything makes sense, even for a moment. He stares at a monitor in the train station, uncertain why he cannot make out what it says. "Did I forget how to read?" he wonders. Then the screen changes. "I experienced a moment of exhilaration fueled by the simple recognition of typed English." He continues to stare at the screen, feeling a charge of excitement whenever English reappears.

His new, unknown self flows like water into any shape offered. When a kind tourist policeman, "Josh," with an "earnest mustache," rescues him and says he has simply taken too many drugs, MacLean conjures up his life as a junkie, right down to a redhead with nickel-size freckles named Christina, his partner in drugs.

A Chinese woman offers to take him in temporarily, and he is immediately certain that he lives in an apartment he can see from her home. Two Christian men visit the now-hallucinating MacLean and pray over him, imploring God to "draw the devil from this boy, Lord." Now his hallucinations take on biblical proportions. God appears. He is Jim Henson.

In the hospital, someone brings him cigarettes. Unaware of his asthma, he becomes a chain smoker.

When his parents arrive, they try to supply the missing pieces so he can reassemble himself. He wasn't a junkie, they tell him. He must stop apologizing. He's a writer, in India on a Fulbright scholarship. He is not crazy. His amnesia and hallucinations are a terrible reaction to the anti-malaria drug mefloquine hydrochloride, marketed as Lariam.

But the reassurance feels suspect. What if it really is his own brain that's shorted out? What if he is never right again? Squeezed between his parents in a rickshaw that begins his journey away from the hospital and toward home to Delaware, Ohio, MacLean is both relieved and secretive; he cannot show just how lost he is. He tries to fake normality.

When his mother tells him Anne and Sally can't wait to see him, he tells her that he can't wait to see them either. He has no idea who they are. Anne is his girlfriend. Sally is his dog. As frantically as he hides his disintegrated self, he hopes that someone will notice how little he should be trusted.

Although he flowed easily into the roles people suggested, he finds his own identity far less welcoming. The man he encounters in old photo albums is no one he can recognize. He writes to old friends and explains what has happened to him, and a former professor, taking this as one of MacLean's usual pranks, responds that he struck his head and can now fly.

Who am I, MacLean wonders, that I cannot be taken seriously? His long pilgrimage to find himself is more painful than losing himself in the first place; like frostbite, a howling ache accompanies the return of sensation.

MacLean developed the memoir from a piece he originally wrote and performed on "This American Life." Now living in Chicago, MacLean, a PEN/American Award winner, has written before about his experiences with mefloquine, including an article in The New York Times.

For years, anyone who traveled to countries where malaria is endemic was advised to take weekly doses of Lariam to prevent it. The drug is no longer available under that name in the United States, but generic versions are. When I took it, I had very vivid dreams, not nightmares, but unsettling for their weird tangibility. That's not an uncommon side effect — ask anyone who's ever served in the Peace Corps in an endemic area.

But for a few, the reaction to the drug is far more frightening, something the drugmaker and the U.S. Department of Defense — which routinely administered it to soldiers — were reluctant to admit, MacLean reports. In July 2013, the U.S. Food & Drug Administration added its most serious level of warning to mefloquine's label. The warning lists the drug's potentially serious neurological side effects, including hallucinations.

MacLean provides a clear and concise outline of the history of mefloquine without attempting a book of medical journalism — a wise choice. To do so would have risked undermining his powerful narrative, turning it into a merely useful anecdote. Although the reality of mefloquine risk has been slow to take hold, much of this has been reported, including a series of more than 40 stories published between 2002 and 2004 by a pair of United Press International reporters, MacLean writes. Among their findings is a 1994 safety review by drugmaker Roche, which addresses suicides in the U.S. armed forces that some associated with Lariam.

The company acknowledged mefloquine could cause depression, which could include thoughts of suicide, but it blamed the actual suicides on "the progressive breakdown of traditional values." It's an absurd conclusion. What scientific test did they apply to determine the role of values? Who was in their control group? A double-blind, randomized study in 2001 was more telling: In a study of nearly 1,000 travelers, half given mefloquine and half a different malaria drug, those on mefloquine had twice as many neuropsychiatric side effects, and nearly twice as many moderate and severe side effects. Oddly, MacLean skips over this critical comparison when he writes about this study.

MacLean tells his story in a series of short chapters, often not much more than a page, and sometimes less, each a complete, polished moment. The arrangement seems nearly inevitable, given the fragmentation of his new reality. And there's another benefit: These bite-size morsels drive the pace. Throughout the book are photocopies of train tickets, physician letters, psychiatric center bills and other ephemera, probably a necessary device after too many James Frey moments in memoir.

But it is not such evidence that makes this book ring so true; it is MacLean's writing and its ability to preserve the naked feelings and the odd and funny moments, such as this one about his first rescuer, a policeman, as he is about to walk away.

I wanted to hug him. I wanted him to never leave. I wanted to sketch a picture of him, to press him between the pages of a dictionary until he was flat and fix him in my diary. "Here is the man who found me," I'd tell people and flip open the book and show them, not a picture, but Josh himself, with that goofy mustache belying any authority he had. I wanted to have him nearby for the rest of my life. Just in case.

But readers who flip open the book will find MacLean, preserved between pages, goofy and serious, lost and found. Still there. Right nearby. Just in case.

Jenni Laidman is a freelance writer who specializes in science and medicine.